Globally, more than half a million women aged 15–49 years die annually from preventable pregnancy-related complications [1, 2]. Women in developing countries have a 1 in 26 chance of dying from pregnancy and abortion compared to 1 in 9400 chances in Europe [3]. One of the factors associated with this outcome is the unmet health need for contraception and reproductive health services. Unmet reproductive health needs exist if there is a gap between a perceived need and the current available options to satisfy the need. This paper focuses on three levels of unmet reproductive health needs: contraceptive service use, obstetric care, and antenatal care utilization.

Identifying relevant measures of women’s reproductive health needs is critical to improve women’s chances of service utilization. The study aims to systematically review and analyze the adequacy of outcome measures and determinants applied in previous studies for assessing women reproductive health needs across West Africa.

Results show increasing unmet need for women’s reproductive health needs. Socio-cultural norms and practices resulting in discontinuation of service use, economic constraints, travel distance to access services and low education levels of women were found to be key predictors of service utilization for contraception, antenatal and obstetric care services. Outcome measures were mainly assessed based on service utilization, satisfaction, cost, and quality of services available as core measures across the three levels assessed in this review.

Specificity of outcome measures in reviewed publications

Table 1

Cross tabulations of outcome measures and reproductive health need at three levels in reviewed publications

Category of outcome measures

Reproductive health needs at three levels for married and non-married women

Antenatal care

Contraceptive use

Obstetric care

Clinical outcomes

1. Number of Antenatal care during pregnancy

1. Service constraints

Critical obstetric danger signs knowledge

2. Place of delivery(Home/facility)

2. Demand satisfied

Preparations by women prior to delivery and facility type

3. Supervised or Non-Supervised delivery

3. Provider Intimidation

3. Facility quality and resources

4. Use of Traditional birth attendant for delivery

4. limited contraceptive choice

4. Obstetric maternal outcomes

5. Mother survival

5. Nurses withholding information

5. Obstetric utilization/complication

Newborn survival

6. Method choices at facilities

6. Quality of obstetric care

Level of utilization and quality of service

7. Unintended pregnancies

8. Language of service provision

8. Unmet contraceptive seeking demand

Economic and geographical outcomes

1. Service utilization for postnatal services

1. Unmet need for contraception

1. Economic access to obstetric care

2. Economic access to service

2. Service constraints

2. Risk of intrapartum and antepartum still birth

3. Out-of pockets payments

3. Economic access

3. Place of delivery

4. Use of modern contraceptives

4. Delay in seeking care

5. Community level/ecological zone

5. Delay in reaching a health facility

6. Delay in been provided with appropriate care

Patient-reported outcomes

1. Service constraints

1. Current use

Demand satisfied

2. Demand satisfied

2. Ever use

Quality of service delivery

3. Quality of service delivery

3. Never use

Awareness of danger signs

4. Decision making choices for maternal care

4. Intention for future use

Emergency planning steps awareness by women

5. Safe delivery

5. Unmet need for contraception

Reasons for seeking abortion and post abortion services

6. Contraceptive prevalence rates

Unsafe abortions

7. Proportion of demand satisfied

8. Knowledge of contraception use

9. Current and Ever use of FP

10. Demand satisfied

11. Quality of service delivery

The extent of unmet need outcomes reviewed in publications

Table 2 summarizes three critical outcome measures reported in the publications reviewed. These outcome measures were mostly assessed and reflect only contraceptive use across clinical, economic and patient levels. Antenatal and obstetric care were not extensively highlighted in the reviewed publications and thus, not included here. As evidenced in Table 2, unmet need for contraceptive use remains high across all countries. Ghana has the highest level of this type of unmet need across West Africa and Nigeria has the lowest rate. Contraceptive prevalence rates are highest in Ghana and lowest in Benin. Modern contraceptive prevalence rate reflects current acceptance and use of modern methods of contraceptive for all age groups. Hence, low rates depict low use and acceptance to modern contraceptive use may translate to low use in the future. Adolescent’s birth rates, though declining, still remain high and stagnant among most adolescent girls in West Africa (see Table 2). Mali and Benin indicated an increase over a five year period (2001–2006). Two countries, Ghana and Burkina Faso showed a remarkably reduction in the rates for various years, however large disparities still exist across all social and economic groups.

Specificity on determinants in reviewed publications

Table 3

Cross tabulations of determinants and reproductive health need at three levels in reviewed publications

Category of determinants

Reproductive health needs at three levels for married and non-married women

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